High glucose or glycohemoglobin levels during embryogenesis are associated with high rates of spontaneous abortions and major malformations in newborns

Increased risk for the mother to develop hypoglycemia, retinopathy, HTN, nephropathy, and CAD

To avoid hypoglycemia in the baby at birth

What 2 counseling points are essential for wmoen with DM of child-bearing potential?

The risk of malformations associated wtih unplanned pregnancies and poor metabolic control

Use of effective contraception unless at good control and actively trying to conceive

What medications associated with diabetes should be discontinued prior to conception?

ACEI

BBL

Diuretics

What are the preconception goals for glycemic control?

Fasting: 80-110

PPG: < 155 at 2h

A1c: < 5%

At what A1c do complications start?

6%

What complications of DM need consideration before pregnancy?

Hypglycemia (increased risk to the mother)

Retinopathy (increased rate of development)

HTN (pre-existing or pregnancy induced)

Nephropathy (may become permanent)

Neuropathy (can be exaerbated and complicate DM management)

CAD (increased risk of mortality during pg)

What is GDM?

gestational diabetes mellitus = any degree of glucose intolerance with onset or first recognition during pg whether insulin or diet modification is used for control and whether or not it persists after pg

What factors place a woman at high risk of developing GDM?

Marked obesity

Personal hx of GDM

Glycosuria

Strong family hx of diabetes

When should women at average or high risk with a negative initial screening undergo testing for GDM?

24-48 weeks of gestation

When should women at low risk of GDM be tested?

they don't require testing

Who are women at low risk for GDM?

< 25yo

Normal wt before pg

White

No 1st degree relatives with DM

No hx of abnormal glucose tolerance

No hx of poor obstetric outcome

What is a one-step glucose tolerance test?

OGTT (oral glucose tolerance test):

100g oral glucose load

check BG at fasting, 1h, 2h, 3h

Should be < 180, 155, or 140 respectively

What is a Two-step glucose tolerance test?

Initial screening 50g oral glucose load should be < 140 at 1h

If not do an OGTT

What are the 7 perinatal complications associated with GDM?

Fetal macrosomia

Neonatal hypoglycemia, jaundice, polycythemia, or hypocalcemia

HTN

C-section

What are the long-term risks of GDM?

Increased risk to develop DM in mother

Increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood

What are the glycemic goals during pregnancy?

FBG < 105

1h PPG = 155 or less

2h PPG = 130 or less

How often should glycemic status be checked post-partum if glucose levels were normal?

at least every 3yrs

How often should glycemic status be checked post-partum if patient was IFG or IGT?

annually

What medications should be avoided in pts with a hx of GDM to prevent development of glucose intolerance/DM?